“NHI won’t happen, billinfringes people’s rights” - experts
Health Minister Aaron Motsoaledi has promised that medical aids will continue to exist alongside National Health Insurance (NHI) - but the very bills he has proposed seem to say the opposite.
In fact, according to experts, the bills say that medical aids can only cover what NHI doesn't. In effect, this means that if the NHI fund covers a caesarean section, medical aids wouldn't be allowed to pay for the procedure, a move that would drastically change how the middle class access healthcare.
It is a contradiction that, experts told this publication, could very well see the health department facing lawsuits.
Section 17 of the proposed Medical Schemes Amendment Bill - announced alongside the NHI bill - says that the "registrar may, after consultation with the minister, restrict the extent of benefits offered by medical schemes, having regards to the benefit and services coverage under the [NHI] fund thereby eliminating duplicative costs for the same benefit".
It is a change that would affect the more than 8million people (17% of the population) who are on medical aid cover.
Senior economist at Econex consultancy Dr Paula Armstrong said: "The way I understand the Medical Schemes Amendment Bill is that if the NHI fund pays for the health services, then medical schemes cannot legally cover the same services. Medical schemes would be for top-up cover and complementary procedures."
Experts, however, warn that the restriction on cover could be overthrown in court.
A professor at the Wits School of Governance, Alex van den Heever, said both the NHI and Medical Schemes Amendment bills tried to restrict what medical aids could offer. "If the government wants to take away a right to healthcare they need to do so with a rational purpose. Rationality is a constitutional principle. Restricting access to private healthcare has no rational reason," he said.
"This is an absurd infringement of the right to healthcare as it would force everyone to use a public health system which cannot be held to account for performance. I do not see this provision ever seeing the light of day as no health system in the world takes away the right of people to select their own care with their own money," he said.
He said the only country that has tried to limit private health insurance was Canada - and it didn't work. "This didn't pass because the Canadian Supreme Court ruled the state couldn't prove people were harmed by being allowed to buy private health insurance."
He called on the government to explain the rationale behind the amendment. "There is no analysis and reason for the new laws they propose. They need to explain their objectives."
If medical aids couldn't cover a procedure, the patient would have to get it done through health services the National Health Insurance fund paid for - which could be state or private. "The waiting list for treatment would just be much longer," said healthcare analyst Dr Nicholas Burger, of Frost and Sullivan.
Van Den Heever wrote the Medical Schemes Amendment Bill in 2008. When it wasn't passed, he worked on the 2010 bill. He said a number of clauses were added that were unnecessary and contradictory.
"They don't know what they are doing," he said. "They have not thought it through. I don't see them reasonably implementing the proposed Medical Schemes Amendment Bill in the foreseeable future."
His analysis of the bill in its entirety? "I get an overriding sense of general ignorance. The NHI won't happen."
Medical lawyer Neil Kirby said there would be multiple ways to challenge the restriction on medical schemes.
Motsoaledi has said committees would decide what NHI benefits would be. But, nine months after adverts for members, committees have not been formed.